Intramedullary Nail Fixation of Distal Tibia Fractures: Tips and Tricks

Talerico, Michael; Ahn, Jaimo

doi:10.1097/bot.0000000000000693

Cited by 14 publications

(16 citation statements)

References 30 publications

(20 reference statements)

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“…Our overall malalignment rate of 25% is consistent with published literature, in which reported rates of malalignment range from 15% to 29%. [ 1 , 2 , 12 , 36 ] Furthermore, more than 80% of the fractures in our study involved the distal third of the tibia, a fracture location for which obtaining satisfactory reduction is known to be challenging. [ 1 – 3 , 6 , 9 ] The average postoperative coronal and sagittal plane alignment (3.72° and 2.43°, respectively) is also consistent with previous literature.…”

Section: Discussionsupporting

confidence: 90%

Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study

Behlmer

Whiting

Kliethermes

et al. 2021

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: To assess the impact of various reduction techniques on postoperative alignment following intramedullary nail (IMN) fixation of tibial shaft fractures. Design: Retrospective comparative study. Setting: Level I trauma center. Patients: Four hundred twenty-eight adult patients who underwent IMN fixation of a tibial shaft fracture between 2008 and 2017. Intervention: IMN fixation with use of one or more of the following reduction techniques: manual reduction, traveling traction, percutaneous clamps, provisional plating, or blocking screws. Main outcome measures: Immediate postoperative coronal and sagittal plane alignment, measured as deviation from anatomic axis (DFAA); coronal and sagittal plane malalignment (defined as DFAA >5° in either plane). Results: Four hundred twenty-eight patients met inclusion criteria. Manual reduction (MR) alone was used in 11% of fractures, and adjunctive reduction aids were used for the remaining 89%. After controlling for age, BMI, and fracture location, the use of traveling traction (TT) with or without percutaneous clamping (PC) resulted in significantly improved coronal plane alignment compared to MR alone (TT: 3.4°, TT+PC: 3.2°, MR: 4.5°, P = .007 and P = .01, respectively). Using TT+PC resulted in the lowest rate of coronal plane malalignment (13% vs 39% with MR alone, P = .01), and using any adjunctive reduction technique resulted in decreased malalignment rates compared to MR (24% vs 39%, P = .02). No difference was observed in sagittal plane alignment between reduction techniques. Intraclass correlation coefficient (ICC) results indicated excellent intraobserver reliability on both planes (both ICC>0.85), good inter-observer reliability in the coronal plane (ICC = 0.7), and poor inter-observer reliability in the sagittal plane (ICC = 0.05). Conclusions: The use of adjunctive reduction techniques during IMN fixation of tibia fractures is associated with a lower incidence of coronal plane malalignment when compared to manual reduction alone. Level of evidence: Therapeutic Level III.

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Section: Discussionsupporting

confidence: 90%

Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study

Behlmer

Whiting

Kliethermes

et al. 2021

OTA International: The Open Access Journal of Orthopaedic Trauma

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“…The nail tip can be accurately inserted into the hardest area of the subchondral bone and the distal interlocking screws can be accurately locked to avoid the "wiper effect" (Fig. 1-g) [27].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiographic Comparisons of Distal Tibia Shaft Fractures Stabilized with an Intramedullary Nail: Blocking Pin Versus Blocking Screw

Wu¹,

Bai²,

Song³

et al. 2020

Preprint

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Background: Distal tibia shaft fractures have a high risk of mal-alignment when treated with intramedullary nailing (IMN). Permanent blocking screws (BSs) and temporary blocking pins (BPs) are often used as supplements to help IMN get good alignment. The purpose of this study was to compare the clinical and radiographic outcomes of temporary BPs and permanent BSs for distal tibia shaft fractures.Methods: From March 2014 to May 2019, a total of 89 patients with distal tibia shaft fractures were included in this retrospective study and divided into two groups. All fractures were located below the isthmus but 4 cm above the tibial plafond. The differences in operating time, intraoperative bleeding, fibula plate fixation, number of BP/BS, initial and final alignment, loss of reduction, fracture healing time, and postoperative complications were analyzed. Functional outcomes of the ankle were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) score.Results: All patients underwent a minimum follow-up of 13 months. The operating time was (73.9±6.1) min and (80.2±8.6) min in the BP group and BS group, respectively (P < 0.05); intraoperative bleeding was (88.2±18.0) mL and (92.9±26.6) mL, respectively (P > 0.05); initial reduction deformity in coronal plane was (0.5±2.3) degrees and (0.9±2.3) degrees, respectively (P > 0.05); final alignment deformity in coronal plane was (1.2±2.7) degrees and (1.3±2.4) degrees, respectively (P > 0.05); initial reduction deformity in sagittal plane was (0.6±2.2) degrees and (0.6±2.4) degrees, respectively (P > 0.05); final alignment deformity in sagittal plane was (0.9±2.3) degrees and (1.0±2.2) degrees, respectively (P > 0.05); As for the loss of reduction, there was no significant difference in sagittal plane between the two groups(P > 0.05). Although the loss of reduction in the coronal plane of the BP group (0.8±0.7 degrees) is statistically higher than that of the BS group (0.5±0.5 degrees), the small difference was not clinically important (P < 0.05). No significant differences were found between the two groups in fracture healing time, AOFAS score and complications (P > 0.05).Conclusion: Both temporary BP and permanent BS can help achieve equivalent overall alignment. However, BP technique is simpler and takes less time.

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“…IMN is more acceptable in the treatment of distal tibial fracture due to the minimized soft tissue dissection, protection of extraosseous blood supply, and superiority in axial loading [20,21]. Some studies have reported that it potentially increased the risk of deformity healing [21][22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Blocking Pins Instead of Blocking Screws in the Treatment of Distal Tibial Fractures with Intramedullary Nail

Bai

Song

Yao

et al. 2020

Preprint

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Background: Distal tibial fractures have a high risk of malalignment when treated with intramedullary nails. The use of blocking screws can aid in achieving satisfactory alignment. The aim of this study was to compare the clinical and radiographic outcomes of temporary blocking pins with those of blocking screws for distal tibial fractures. Methods: From June 2011 through November 2018, a total of 90 patients with distal tibial fractures were enrolled in this prospective randomized controlled study. The patients were randomly received either blocking pins or blocking screws reduction during nailing. After reduction, 5 points at the distal fragment were effectively fixed. Results: The operating time in the BP group was 73.77±6.25 min, which was significantly shorter than 80.05±8.51 min in the BS group (P<0.001). The time to healing in the BP group was shorter than that in the BS group (18.52±4.57 vs. 21.51±3.17 weeks; P=0.001). The coronal and sagittal plane deformities at any time points were comparable (all P＞0.05). During the 12-month follow-up period, patients had an average change in the coronal plane of 1.34 degrees in the BP group and 1.00 degrees in the BS group (P=0.120), as well as an average change in the sagittal plane of 1.09 degrees and 0.81 degrees (P=0.110), respectively. Malunion was seen in two patients (5%) in the BP group and one patient (2%) in the BS group ( P＞0.05). Conclusion: The blocking pins can help achieve satisfactory alignment for distal tibial fractures during nailing. Intramedullary nails without blocking screws can afford adequate stability to maintain the reduction during the healing process when an effective five-point anchoring fixation is achieved.

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Intramedullary Nail Fixation of Distal Tibia Fractures: Tips and Tricks

Cited by 14 publications

References 30 publications

Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study

Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study

Clinical and Radiographic Comparisons of Distal Tibia Shaft Fractures Stabilized with an Intramedullary Nail: Blocking Pin Versus Blocking Screw

Blocking Pins Instead of Blocking Screws in the Treatment of Distal Tibial Fractures with Intramedullary Nail

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